Terapi sasar pikeun kanker koloréktal

Naon ubar target kanker colorectal?

17 years ago, the number of drugs available for advanced colorectal cancer was very limited. There were only a few chemotherapeutic drugs and almost no targeted drugs. Once diagnosed, the survival period is only between half a year and one year. But now, cancer treatment is entering the era of precision treatment, and more and more targeted and immune drugs are on the market.

In the 2017 version of the colorectal cancer treatment guidelines, the recommendations for genetic testing only involve KRAS, NRAS, dMMR, and MSI-H. In the latest treatment guidelines for 2019, new targets such as BRAF, HER2, NTRK are newly included Point, through genetic testing, to understand more molecular information about colorectal cancer, can help us find more medication options. The average patient survival rate is more than 3 years, which is a huge improvement brought by precision medicine.

Gén anu mana anu kedah diuji dina penderita kanker koloréktal?

Saatos diagnosis, dokter kedah sacara genetik nguji unggal pasién sareng kanker kolorektal metastatik (mCRC) sakedap pikeun nangtoskeun subkumpulan panyakit, sabab inpormasi ieu tiasa ngaduga ramalan pangobatan, sapertos amplifikasi HER2 nunjukkeun nunjukkeun résistansi anti-EGFR. Gén ieu kedah diuji!

MSI, BRAF, KRAS, NRAS, RAS, HER2, NTRK.

Targét sareng udagan udagan ayeuna sayogi kanggo dirawat

VEGF: bevacizumab, aparcept

VEGFR: Ramulizumab, Regigofinil, Fruquintinib

EGFR: Cetuximab, Panitumumab

PD-1 / PDL-1: Pamumab, Navumab

CTLA-4: Ipilizumab

BRAF: Wimofenib

NTRK: Larotinib

List of colorectal cancer targeting and immunotherapy drugs that have been approved so far at home and abroad:

Indikasi pikeun bevacizumab: kanker kolorektal métastatik jeung kanker paru sél non-leutik maju, métastatik atawa kambuh.

Indikasi pikeun trastuzumab: HER2-positive metastatic breast cancer, HER2-positive early breast cancer, and HER2-positive metastatic gastric adenocarcinoma or gastroesophageal junction adenocarcinoma.

Indikasi Pertuzumab: This product is suitable for combination with trastuzumab and chemotherapy as an adjuvant treatment for patients with HER2-positive early breast cancer with a high risk of recurrence.

Indikasi Nivolumab: negative epidermal growth factor receptor (EGFR) gene mutation and anaplastic lymphoma kinase (ALK) negative, disease progression or intolerable locally advanced or metastatic disease after previous platinum-containing chemotherapy Adult patients with non-small cell lung cancer (NSCLC).

Indikasi Regorafenib: previously treated metastatic colorectal cancer patients. Durvalumab, Tremelimumab, Ipilimumab, lapatinib are not yet available in China.

Terapi Targeting Colorectal (Pembaruan 2019)

1. Terapi sasaran kanker kanker kolorékal négatip

Kanker kolon tipe liar KRAS mangrupakeun perlakuan garis kahiji standar pikeun kémoterapi sasaran dina kombinasi kalayan kémoterapi. Janten naon jinis kémoterapi anu dipilih?

Nalika milih ubar anu ditujukeun, disarankeun milih rézim kémoterapi kalayan OS anu langkung panjang, nyaéta cetuximab langkung cocog pikeun FOLFOX, sareng bevacizumab langkung cocog pikeun FOLFIRI. Rencana anu mana milih gumantung kana analisis klinis khusus:

Upami aya harepan pikeun ngubaran, cetuximab digabungkeun sareng kémoterapi umumna dipikaresep kusabab épéktipitas objektif cetuximab anyar langkung luhur tibatan bevacizumab;

Pikeun pasién anu ngagaduhan panyakit canggih anu teu tiasa diubaran, bevacizumab digabungkeun sareng kémoterapi tiasa dianggo garis kahiji, dituturkeun ku cetuximab atanapi panitumumab.

2. Perawatan kanker kolorektal Kras-positip

Pasien sareng kanker usus besar metastatik kedah diuji status mutasi RAS kalebet KRAS sareng NRAS, sareng sahenteuna status KRAS exon 2 kedah jelas.

Upami tiasa, status exons sanés kajabi KRAS Exon 2 sareng status mutasi NRAS kedah diklarifikasi.

Bevacizumab combined with two-drug chemotherapy can bring PFS (median progression-free survival) and OS (overall survival) benefits to patients with KRAS mutations.

Pikeun pasién anu mutasi RAS, panggunaan cetuximab tiasa mangaruhan pangaruh négatip dina kamampuan sacara umum. Pasén anu mutasi KRAS atanapi NRAS kedah henteu nganggo cetuximab atanapi panitumumab.

3. Perlakuan kanker colorectal BRAF mutant

7-10% pasien kalayan kanker usus besar ngagaduhan mutasi BRAF V600E. Mutasi BRAF V600E mangrupikeun mutasi anu diaktipkeun ku BRAF sareng ngagaduhan proporsi paling luhur tina mutasi BRAF. Boga ciri klinis anu unik: utamina nembongan dina hemisolon anu leres; babandingan dMMR luhur, ngahontal 20%; Mutasi BRAF V600E gaduh ramalan goréng; pola metastatik atipikal;

Panilitian parantos mendakan yén FOLFOXIRI + bevacizumab tiasa janten pangobatan anu pangsaéna pikeun pasién anu mutasi BRAF. Pedoman 2019 V2 NCCN nyarankeun pilihan perlakuan baris kadua BRAF V600E pikeun kanker kolorektal metastatik: verofinib + irinotecan + cetuximab / panitumumab Dabarafenib + trametinib + cetuximab / panit MAb

Encorafenib + Binimetinib + Cetux / Pan

4. Panguat2HERXNUMX

HER2 amplification or overexpression is found in 2% to 6% of patients with advanced or metastatic colorectal cancer. Pertuzumab and trastuzumab bind to different HER2 domains to produce synergistic inhibitory effects on tumor cells. MyPathway is the first clinical study to investigate the efficacy of Pertuzumab + Trastuzumab in patients with HER2 expansion metastatic colorectal cancer (regardless of KRAS mutation status). This study shows that HER2 dual-targeted therapy, Pertuzumab + Trastuzumab, is well tolerated or could be used as a treatment option for patients with HER2 expansion metastatic colorectal cancer. Early genetic testing to identify HER2 mutations and consider early use of HER2 targeted therapy may benefit patients.

5. Perlakuan kanker kolorektal fusi NTRK

Fusi NTRK lumangsung dina sakitar 1 dugi ka 5% pasién kanker usus besar, sareng dianjurkeun tés NGS. Lorarectinib disatujuan pikeun pangaturan ulang NTRK di penderita tumor padet, kalayan ORR 62% sareng 3 diantarana kalayan CRC. Munculna sambetan TRK sapertos larotinib sareng emtricinib nyayogikeun ideu terapi anyar pikeun NTRK gen fusi CRC.

Awéwé yuswa 75 taun kangker kanker kolorektal metastatik (CRC) untung pisan:

Tumor kolon primér.

Kanker peritoneal.

Metastasis ati.

1600 mg / m 2 tina emtricinib dikaluarkeun sacara lisan saminggu sakali salami 4 dinten berturut (nyaéta 4 dinten / 3 dinten cuti) sareng 3 minggu berturut unggal 28 dinten. Aft
er dalapan minggu pangobatan, lesions nyata ngirangan.

Concluding Katerangan

Ngalebetkeun jaman terapi anu ditujukeun, unggal pasién anu kanker kanker koloréktal kedah lulus uji MSI, analisis mutasi RAS sareng BRAF, sareng ngalakukeun panguat HER2 saloba-gancangna, deteksi gén sapertos NTRK, sareng tés genetik (NGS) bakal dilebetkeun kana ageung kriteria ujian Awal kanggo kaseueuran pasien.

Kanggo inpo nu leuwih lengkep nelepon +91 96 1588 1588 atawa nulis ka cancerfax@gmail.com.